After having Restylane injected to my tear troughs...
After more than a year of feeling miserable about my eyes, I sought out a consultation with Dr. Kami Parsa, an oculoplastic surgeon in Los Angeles, who has lots of glowing reviews on Real Self and other sites to discuss my options for addressing my hollowing and undereye bags. While most dermatologists and plastic surgeons are as yet unfamiliar with the risk of biofilm infection from temporary fillers, Dr. Parsa had written a paper on the subject.
I liked Dr. Parsa very much, his credentials are impressive, and he is known for performing complicated revision surgeries successfully. Most impressive is that he donates his services to perform surgeries on third world children with eye deformities. Considering how much my procedures will cost, I feel good about paying the money to a surgeon who gives back to the world.
Dr. Parsa recommended an upper and lower blepharoplasty with fat repositioning, along with midface fat injections to treat the hollowing, and SmartXide DOT laser resurfacing.
I have no qualms about the lower bleph, but I am nervous about the other procedures. With the upper bleph, I am worried about not looking like myself afterwards, and think of all the photos of bad plastic surgery with the deer-caught-in-the headlights look. I do not want to look different. I do not want to look younger. I only want to look refreshed and well-rested, without the bags. The before-and-after photos and Dr. Parsa's website have a very natural look, so I am not too worried about this.
As for the other procedures, I've read many horror stories on RealSelf of bad experiences with fat transfers and laser resurfacing, and I am most nervous about the laser resurfacing. It sounds like a very aggressive procedure, deliberately damaging the skin, that is painful and looks horrible during recovery. I am nervous about being red for weeks or months, and some people report permanent scars and marks. Many people report no improvement afterwards. Apparently, one treatment is not usually enough, and this is not something I want to do to myself repeatedly (nor can I afford repeated treatments). I would love to hear from anyone who has had experience with this procedure.
Since I live out-of-state, I will meet with Dr. Parsa the day before my procedures. I'm debating whether I should opt out of the laser. Or will I be left with crepe-y skin after the procedure, and wish I'd done it?
I will continue to update after the surgery and recovery process. Would welcome any feedback!
Night Before Surgery
This afternoon I met with Dr. Parsa my fears were allayed. As other people have written about Dr. Parsa, he is kind, caring, patient, and compassionate. He listened to all my concerns, and I never felt rushed. He wanted to make sure that he had addressed every single one of my questions.
I told him that I was most worried about the laser resurfacing, and fears I had based on accounts I've read on RealSelf. He told me that he uses a very low setting on the SmartXide DOT laser and is very conservative with the treatment, and that most of the horror stories are due to overly aggressive treatment.
I still wasn't convinced that I wanted to do the laser, and he reassured me that it could always been done at a later date, should I so choose, but that it was likely I'd be left with some loose crepey skin under the eyes after the transconjunctival lower bleph.
He mentioned that the other way to address the loose skin would be with a "skin pinch" to the lower eyelid. It sounded at first like an easy fix and simple solution to me, but after doing a little more research here, I realize that a skin pinch is more surgery and involves cutting and extra sutures. Worst case scenario is that it can change the eye shape.
So I've finally decided to go with the laser treatment is a skin treatment. I figure that the possible complications from the laser wouldn't be nearly as bad as possible complications from extra surgery.
I've made my decision, which feels good after weeks of angst. I totally trust my surgeon, who is an oculoplastic surgeon who specializes in revisions. He has handled cases far more complicated than mine (doing charitable work performing plastic surgery on children with gross deformities). I feel like I will be in the best of hands.
That said, I know the healing process will be unsightly and unpleasant. I know that I will have doubts and panic attacks during the healing process. But I am putting my energy now into visualizing a positive outcome and the joy I will feel when I won't feel the need to hide behind glasses anymore.
Now I must take my meds and remedies and get to bed. I need to be at the surgery at 6:30 tomorrow morning. Please think good thoughts for me!
Less than an hour before surgery
Surgery, Day 1 and Day 2
After weighing the pros and cons of laser resurfacing vs a skin pinch to address the loos skin after lower bleph, when I met with Dr. Parsa in the morning before surgery, I told him I was still conflicted and asked what he would recommend if I were a family member. He told me that he takes much pride in his work and considers every patient his family and always recommends what he feels is best. He suggested that I trust his judgment and that he would know the best course of action once surgery had commenced. I trusted him completely and agreed to let him surprise me.
I was made so comfortable during the surgery, in a warm, heated bed. His nurse Brian and anesthesiologist (Lisa?) were super nice and reassuring. Once the IV was put in, I was out in seconds.
Next memory was coming to in the recovery room with a wonderful nurse (whose name, sadly, I forget). I remember Brian coming by and telling me the surgery went really well and that I was going to love my new eyes. I did have pain when I woke up. The nurse asked to rate it on a scale of 1 to 10. I said 6, and she gave me some Demerol via IV.
As soon as I became conscious I wanted to know if Dr. Parsa chose to do the skin pinch or the layering. He finally came in and told me that he had done a small skin pinch and VERY light layering, just over the tear trough area.
Not long after I woke, my husband came to pick me up. I was woozy and wobbly, and they brought me out the car in a wheelchair. I was alert enough, though, to snap a picture in the car immediately after surgery.
Rested with ice packs most of Day 1. Dozed off an on. After the Demerol wore off, I had no pain, just my eyes feeling weird and tearing a lot. Oh, and the nurse told me to expect bloody tears for the first day. (Yuck!) Even though I have a prescription for Vicodin I have not taken so much as a Tylenol since I got home. No pain whatsoever, except for a sore throat from the breathing tube. I keep coughing up phlegm, which I think was related to the breathing tube.
By evening, I began to swell, but it looks like I don't have too much bruising, which I am thrilled about! I have armed myself with a battery of homeopathic remedies to combat bruising and swelling: Sinnech (a high potency Arnica specifically for surgery), Staphysagria (homeopathic remedy for healing surgical wounds), Hypericum (for nerve pain), Traumeel Oral Drops, and Bromelain.
I bought two eye masks by IMAK that can be put in the freezer, a tip from Jill, one of the RealSelf community managers after her lower bleph. When one gets warm, you can replace it with the cold one from the freezer. The mask can be purchased on Amazon: http://www.amazon.com/IMAK-Eye-Mask-Pain-Relief/dp/B000VHYLFW/ref=sr_1_1?ie=UTF8&qid=1390687501&sr=8-1&keywords=imak+ergo+beads+mask.
Now it's Day 2 and there is definitely more swelling, especially my upper eyelids where are bright red and puffy. Feeling a little more alert. My husband cannot understand why I would choose to do this to myself, but has been wonderfully supportive, cooking for me and making me comfortable.
Dr. Parsa has been so kind and understanding throughout and gave me a number to call him at any hour and stressed that no question was too trivial. He called me both days to check up.
I know that today and tomorrow I will probably look the worst, but based on the photo I snapped before the swelling began, I am hopeful about the eventual outcome.
Will keep you posted!
Swelling Going Down
Day 4 - Out and About
So freshly cleaned and pressed, I donned a pair of big sunglasses and a hat, and my husband and I went to Santa Monica. It felt amazing to be out in the big, wide world again! It was a beautiful day in L.A. We had a lovely lunch at an outdoor cafe, where half the patrons were wearing sunglasses, then had a long walk down the Santa Monica pier.
With my sunglasses on, I looked perfectly normal.
By evening, my eyes felt tired and really dry. I was using the artificial tears constantly. Tried to do a little work on my computer, but it really tired my eyes, plus the antibiotic ointment I have to put directly in my eyes makes everything blurry.
I saw Dr. Parsa this afternoon for a follow-up. He thought I was healing nicely and normally and reassured me that I am still swollen and that all I need to do now is to allow myself time to heal.
In Dr. Parsa's handouts, he included a very helpful guide on what to expect emotionally. It said that it was typical during the first week to get depressed and teary, which hit me on Day 5. As we were leaving his Beverly Hills office, I saw a homeless black woman (whom we had passed earlier on our way in) being handcuffed and arrested by a squad of policemen. When we got to our car, I burst into tears. It made me think about the sick, the homeless, and the destitute. It made me think of all the injustice in the world and made me feel guilty for being a "have" in a world of "have-nots." I felt ashamed of being so self-centered as to elect to have this surgery. Later that night, I read about Pete Seeger's death. Pete Seeger was a very influential person in my life, and even though he lived a long life into his 90's, I couldn't stop crying.
I was grateful to Dr. Parsa for letting his patients know to expect to be on an emotional roller coaster the first week after surgery.
To Grace60: I asked Dr. Parsa about why some doctors routinely perform a brow lift along with an upper blepharoplasty. He seemed incredulous and didn't know why any doctor would *always* do this. He said that every patient's anatomy is different and that there is never one-size-fits-all when it comes to surgery. He said that he is personally not a big fan of brow lifts, saying that it can result in an unnatural, "surprised" look. I felt reassured that my brows are not going to fall once I heal.
I'm right on target for Dr. Parsa's handout on what to expect the first week:
"Irritation, sadness, anger, 'What have I done?', criticize, scared, impatient."
I can't bear to look at my photos or myself in the mirror. When I smile, my eye bags are worse than ever and I feel like I'm stuck with them for the rest of my life. I'm worried that the corners of my eyes are turning downward. It seems like one side of my face has more "cheekbone" from the fat injection, and that I am asymmetrical. I am indeed wondering what I have done to myself.
I fly home after two days. Worried what I will do if I have unsatisfactory results, given that I live on the east coast and Dr. Parsa is 3,000 miles away.
I know that this is to be expected, and that I am still swollen, and that the swelling is probably receding unevenly, but I still feel scared and depressed. I would really welcome hearing from anyone right now who went through this the first week and can reassure me that they love their end results.
Thanks for listening.
Day 7 - Stitches Out!
Saw Dr. Parsa at 11:00 this morning to have my upper eyelid stitches removed. (The stitches from my skin pinch are dissolvable.) Pinched a little, but didn't hurt. Dr. P. thinks I am healing nicely, and allowed plenty of time to answer my myriad of questions.
Of course, I am in the "bouts of doubts" phase and worried about so many things. Dr. Parsa and is assistant Marie, told me not to look in the mirror, and to just give my body time to heal. Dr. P reassured me that I am still swollen and that the bags will go away, and the results will get better and better in time.
Later that afternoon, I put the artificial tears, and started dripping bloody tears from one eye! I'd had no bleeding since the day of surgery. Called the office. They told me to come back in. Luckily I am staying only 10 minutes away.
Dr. P. examined me and thought that I may just have dissolved some dried blood. Told me not to worry. We said goodbye to each other, since I was flying back to the east coast two days later, and agreed to have a Skype call in a week to see how things are progressing.
The bruising is all but gone, and the swelling reduced, so on Day 7 I went out to dinner with my husband and just wore regular glasses. No sunglasses! I'm not to wear eye makeup for three weeks, but I did put a little Bare Minerals concealer on the remaining bruised spots, and a little blush on my lower cheekbones. Nobody stared at me.
I'm trying not to look in the mirror, but am having a hard time, and continue to worry endlessly.
Emotonal and Physical Reactions After Cosmetic Surgery
One Week Out
Now that it has been one full week since surgery, I can see now what a huge positive difference it has made, compared to the photo that I snapped moments before surgery. My eyes still feel tired and raw (as if I'd been crying for 12 hours straight), but I'm amazed that they already look more or less normal. I thought I would be flying home wearing sunglasses on the airplane, but there was no need. My vision is still blurry and I'm having trouble reading, with or without my glasses.
I don't know what to attribute my minimal bruising to -- good health, genes (doubtful, I've bruised easily in the past), the arsenal of homeopathic and naturopathic remedies, or Dr. Parsa's skill as a surgeon. Probably a combination of all these things.
But if you're wondering, here's what I did, and worked for me:
* No alcohol for a month before surgery (I'm not a big drinker, and I don't smoke).
* No wheat for three weeks before (inflammatory).
* One hour of aerobic exercise 3 x a week (more regular than usual) for two weeks before.
* Avoided all the blood-thinning agents on Dr. P's list (ibuprofen, fish oil, etc.) for three weeks before.
* Started this brand of Bromelain for days before surgery, and continued after surgery till bottle was empty:
* Took Boiron Arnica pellets, 30c, 3 x a day for 4 days before surgery
* Started taking SinEcch (high potency arnica) one-hour before surgery, following directions on box till gone.
* Homeopathic Staphysagria 30c (for healing surgical wounds) starting immediate after surgery:
* Homeopathic Hypericum 30 c (for healing nerve damage) immediately after surgery.
* Traumeel Oral Drops - two days before surgery and for a week after
* Instead of putting Aquaphor (basically just Vaseline) on my lasered areas, I used Arnica ointment in a petroleum base.
http://www.amazon.com/Boiron-Arnicare-Arnica-Ointment-Relief/dp/B00016QTOO/I have no redness at all from the lasering.
It may be because Dr. P used such a low setting, but I seemed to heal quickly from that, too.
All these were in addition to the oral antibiotic and eye ointment that Dr. P prescribed. I have a close friend who's a homeopath who made these recommendations. I know that many doctors scoff at homeopathic remedies and feel there's no science behind it, but Dr. Parsa is a big believer in the power of natural remedies to assist the body in healing itself, which I appreciate.
In addition, I highly recommend buying two Imak eye masks to rotate in the freezer (as mentioned in a previous post):
If you wet them first and keep them in a plastic bag, they will stay cold longer.
Trying to sleep on my back was one of the hardest parts of recovery and I went a good four nights without sleeping well. I had a TravelRest travel pillow which helped, but wish I'd had THIS, which I just discovered today!
After my experience trying to sleep this past week, I had the idea to design a pillow just like this to support one's head, but discovered someone beat me to it! Since sleeping on one's back is supposed to prevent face and chest wrinkles, I think I'm going to order it and try to learn to sleep on my back. You would want to put this on top of two other pillows to keep your head elevated.
A lot of info, I know, and maybe overkill, but I REALLY wanted to avoid bruising. Hard to say isolate which of these remedies was most effective, but I was willing to try them all since homeopathic remedies are 100% safe.
You can find most of these remedies at your local health food store. I am not a big fan of Amazon, and only include the links here for illustrative purposes.
Hope some of you might find this helpful!
I also notice that the incision on my left eye looks like a deep wrinkle, where my right eye looks flat.
I wake up with a lot of swelling and lumpiness, which gradually lessens during the day, but still a lot of puffiness and asymmetry. Wondering how I'll look next Monday when I go back to work and if anyone will notice I look different. I haven't told my co-workers. They know I've been on "vacation." Hopefully, they'll just think I look well-rested after my vacation.
Day 11 - Freaking Again
I *know* I'm less than two weeks out, and I *know* that this is the self-critical phase, but I can't seem to control my worry. Researching asymmetry after blepharoplasty on RS and read some doctors suggesting revision to patients who are only two weeks out like me and my freak-out meter goes up to the red zone.
Please talk me down off of the cliff! Would love to hear from anyone who's had a bleph, experienced asymmetry and seen it resolve in time.
Day 13 - No More Dry Eyes
My vision, on the other hand is still off. Can't read my computer screen with my glasses, and have to get very close. (I am near-sighted.)
Had a Skype call with dear, patient Dr. Parsa. Reassuring as always. Stressed again the importance of giving my body time to heal and emphasized the POWER OF POSITIVE THINKING. I'm really working on this, and on visualizing a beautiful, healthy outcome.
He also cautioned about comparing oneself to other cases on Real Self because *everyone is different.* The type of surgery he did on me at my age, after having Restylane injected to my tear troughs and a subsequent infection, would be entirely different from someone who is older or younger, whose anatomy is different, or who has different problems. Again, there is no one-size-fits-all when it comes to surgery. Keep that in mind when you are viewing other people's stories and photos.
Dr. Parsa has been so patient with all of my worries, freak-outs, and questioning. I have so much in confidence in his judgment and skills. Please know that all the worries I have posted here are just, at this point, journaling the emotional process I am going through. After the year I spent living with the biofilm infection and being so self-conscious of my lumpy eye bags, it's hard not to scrutinize my eyes and to worry about every little thing I see, fearful that my eyes will never look normal again.
I am looking forward to week three when Dr. Parsa's handout says the thinking typically shifts from self-scrutiny to realizing how good you are starting to look. Fingers crossed!
Beauty Keeper Back Sleeper Pillow - Review
After the first week of recovery, I had in mind a pillow that I wanted to design that would combine a foam pillow with cervical support (I also tend to wake up with neck pain) and head support on either side. I find the hardest part of sleeping on my back is not having head support when my head falls to one side or the other during sleep. It takes a lot of muscle effort to keep one's head upright when sleeping.
Well, I started searching Google for such a pillow and discovered that someone beat me to it and designed just the kind of pillow I had in mind -- the "Beauty Keeper Back Sleeper" pillow. Even though I was past the critical first week of needing to sleep with my head upright, I learned the benefit of sleeping on one's back for preventing not only facial wrinkles, but also "cleavage wrinkles." In recent years I have noticed wrinkles on my chest that I thought were from age and too much sun, but learned can be made worse by sleeping on one's side, compressing the breasts against one another. I decided that I'd like to train myself to become a back sleeper.
So I ordered the pillow which, admittedly, is a little pricey at $79.95, but so glad I did. The flat part of the pillow is memory foam, molded to offer cervical support to the neck, with foam bolsters on either side to support the head. It makes it SO much easier to sleep on one's back, and I have sleep soundly on it for the past four nights, waking up refreshed in the morning still on my back. And I notice my cleavage wrinkles have all but disappeared.
I really wish I had discovered this *before* my surgery. Would have made the first week so much easier. I HIGHLY recommend this pillow if you are scheduled for facial plastic surgery, or if you would like to transition to sleeping on your back.
This is a new product. From what I can tell, the company is only about a year old. The pillow is available on the company's website at http://back-sleeper.com/
Days 14 to 19
I was obsessing about the asymmetry of my eyes, noticing that in every photo since surgery, my left eye appears smaller and droopier. I was worried that my upper eyelid incisions are healing differently. The left eye incision is deeper and indented, causing a deep wrinkle and droopy look, whereas the right incision looks perfect and is healing flat. Even though Dr. Parsa keeps assuring me that all will be well and that the asymmetry will resolve in time, I've found it very difficult not to worry.
But I've gone back and looked and pre-surgery photos of myself and noticed that my left eye has always looked slightly smaller and that my eyes weren't symmetrical before. I had no idea. Just an illustration of how much more critically we look at our faces after surgery!
Last weekend, I went out socially for the first time with friends. I felt extremely self-conscious. Granted it was evening (went to a concert) and not very well-lit, but no one mentioned a thing, and no one stared or looked oddly at me. I was surprised and relieved.
I returned to work on Monday. I work with two other people and again, neither has said a thing or looked oddly at me. (YES!) But I am wearing my glasses which helps. I do feel self-conscious when they are making eye contact with me, and I find myself wanting to avoid eye contact.
I just noticed how much my vision has improved. I can now see my computer screen from a normal distance with my glasses on. For the past two weeks, I had to take my glasses off and get very close to the screen to see clearly. The dry eyes have vastly improved. I usually just use the artificial tears first thing in the morning and before bed.
I've had two Skype calls with Dr. Parsa since returning home. He is SO reassuring, and everything he has told me about the healing process is going as described.
Today (Day 19) was the first day since surgery that I finally felt like I am going to be happy with my new eyes. The asymmetry seems to be improving, the deep wrinkle/scar on my left eye seems to be softening. On Friday, I will begin using Biocorneum (a silicone product) to help heal the scars.
I've been using Bare Minerals powder makeup. Using a little bit of a dark charcoal along my upper lash line. At the three week mark, Dr. Parsa said I can start wearing more make up, but that it should be very easy to remove and that I must be very gentle with the removal. No waterproof mascara!
He has stressed over and over that he wants all his patients to be happy with their results and is always available for questions or consultation. He has never made me feel rushed and answers my emails promptly. Truly a kind and caring human being. I feel assured that if anything should not heal according to plan, Dr. Parsa will take care of me.
I feel like I've turned a corner, and Dr. Parsa assures me that for the next three months, things will continue to look better and better.
Thank you to all who have read and commented, and supported me on this journey. I've learned what a huge amount of courage it takes to choose to change one's facial features. It is a huge gamble and while the results are most often gratifying, the results can sometimes be heartbreaking.
Having read so many stories of complications and heartbreak, I think it is SO important to research and choose a surgeon carefully, being willing to travel, if necessary, to put yourself in the most capable hands. I think it is as important as choosing a husband! You may well be living with your face longer than with your partner.
At 3 weeks, I was feeling really good about my eyes and feel like they've looked their best so far (with some Bare Minerals concealer and a some dark shadow to line my upper eyes). I was starting to feel more confident and hopeful. I think now that I was still benefiting from the "honeymoon swelling" which was helping to fill my undereye hollows.
At this point, my biggest concern was that the indented scar on my left eye, which was making a deeper crease and, I felt, was making my left eye appear droopier than the right.
Outer Left Corner of Left Eye Drooping
Day 33 - What a Difference a Day Makes!
Dr. Parsa said the sagging was due to fluid retention and swelling. The swelling, naturally, is worse first thing in the morning and, sure enough, the alarming photo I posted yesterday was taken first thing in the morning. By the end of the day, when I Skyped with Dr. P., the sagging lid looked much better.
He stressed again the importance of avoiding salt, and he instructed me to start using the steroid drops again -- twice a day for 5 days, then once a day for another 5 days -- to help resolve the swelling. Because I live in the cold, dry northeast, he suggested that I also start running a humidifier to help with the redness and irritation.
Snapped a new picture today, after I've been up for a few hours with a little make-up on. What a difference a day makes, don't you think?
Just a bit of advice to those of you who are pre-surgery or in the early days post-surgery: be prepared for day-to-day changes in the appearance of your eyes and for your healing to be a roller coaster ride. My eyes looked much better to me at 3 weeks than they did at 4 weeks. Dr. Parsa assured me that this is normal. He reminded me of all the things he's been right about so far when addressing my numerous questions since surgery. He asked me to trust him about the sagging eyelid, and assured me that I don't have ectropion.
I do trust you, Dr. Parsa! Thank you for putting up with me.
6 Weeks - Up and Down
Photos to Post Above -Week 6
You Must Think I'm Nuts!
Wearing Contacts Again
9 Weeks - Still Concerned About Asymmetry
My scars are healing nicely and becoming less visible. I still wake up with some swelling in the morning, which dissipates as the day goes on. My incisions itch a little from time to time, but not badly. Tenderness has all but gone away.
My left eye still appears smaller, less open than my right eye. My friend who is an esthetician noticed it. The smaller left eye was noticeable in the first photo taken immediately after surgery and is still noticeable. I keep hoping it will improve in time, and have read several reports on RealSelf of asymmetrical eyes that took 6 months to a year to resolve. So I am trying to be patient! Even if it doesn't go away, I don't think it's noticeable to most people.
Of more concern to me is the big bag under my right eye when I smile. It seems apparent to me that there is a bigger hollow (less fat injected? less fat took?) under my right eye. I must confess that I'm a little depressed right now to have had lower eyelid surgery to get rid of the bags, and to still have this big bag under one eye, and am self-conscious of this additional asymmetry.
I will be back in LA to follow up with my doctor in May, but that is more than six weeks away. By then it will be past the three-month mark. I am hoping that if I need more fat injected under my right eye that it can be done then.
In the meantime, trying to stay positive and be patient, knowing that my final results won't be apparent for a long while, and that Dr. Parsa will make any tweaks needed for a satisfactory result.
I must confess that it is hard to read the reviews from people who are only a few weeks post-surgery and thrilled with their results. For some of us, it's a long waiting game, requiring faith and patience.
Changed User Name
I am only 2.5 months post-surgery and still healing. Even though my final results have yet to be seen, there is already dramatic improvement in my appearance. Most importantly Dr. Parsa rid my undereye area of previously injected Restylane which had caused a nasty biofilm infection and caused swelling, tenderness, and misery for over a year. Most plastic surgeons and dermatologists remain unfamiliar with the risk of biofilms from temporary filers and how to treat them. I have had no symptoms of the infection since my blepharoplasty. I chose to travel across the country to have Dr. Parsa perform my surgery, not only because of all the glowing reviews of his skills as an oculoplastic surgeon, but also because he is an expert on biofilm infections and researches, writes, and teaches on the subject. Dr. Parsa is one of the kindest, most caring, and compassionate doctors I have ever met. He has spent so much time with me, reassuring me every step of the way. He is always available by email or Skype any time I have a question or concern (and there have been many!). I always feel reassured after speaking with him. His assistant Marie is similarly responsive, warm, and friendly. Even though I am not yet fully healed, Dr. Parsa has reassured me that if anything needs tweaking in 6 month or a year, that he will take care of it. He takes great pride in his work, treats all his patients like family, and wants all of his patients to be happy with their results. Thank you so much, Dr. Parsa. I feel so lucky to have found you!